Tuesday, July 10, 2012

Making use of quacks

One of the major problems with the Indian healthcare system is the large number of unqualified quacks who dispense medical care . These quacks can be dangerous. They give injections for no good rhyme or reason , creating infections transmitted by unsterile injection practices ; they use antibiotics indiscriminately , leading to the propagation of antibiotic resistant bugs; and they often make the wrong diagnosis, causing needless suffering.. While it's true that quacks can cause a lot of harm, we need to accept that they are a fact of life in the present Indian healthcare system. Whatever our personal view about them maybe, the fact that they continue to flourish means that they must be serving a useful function in society . We need to take advantage of the fact that they have an extremely efficient network , and use this, so that they can provide good quality healthcare, rather than continue to be a menace .

We need to stop looking down on quacks and treating all of them as crooks. Just like there are good doctors and bad doctors, we need to acknowledge that there are bad quacks and good quacks ! Rather than concentrate on rooting out the bad quacks, we need to focus our attention on the good quacks , so that they become better !

Quacks have been self-selected and have a lot of courage and hubris – remember that it’s not easy to set yourself up in practise as a doctor, if you do not have the requisite training ! Not all quacks are greedy – some do this because they have a desire to heal people . We need to tap into this ! This is a useful internal drive , which helps them to provide care to others. This is one of the traits we try to select for , when we recruit medical students for medical colleges - and quacks , simply by virtue of the fact that they have been in practice for so many years , have actually proven that they have this particular trait !

Many quacks have been in practice for many years. The reason they flourish in underserved areas is because trained doctors are not willing to put up with the hardships involved in practicing in these settings ( extremely poor slums; or remote villages). They have a certain social standing ; the community respects them , and is willing to trust them. Rather than force qualified doctors to practice in areas they do not want to, we can tap Into this trust , and leverage the efficiency of the quack, so we can make them more productive healthcare workers, rather than treat them as being a menace to society.

While it is true that they can be dangerous , it is also equally true that by providing them with the right information , they can actually become useful frontline healthcare workers. Most quacks would much rather provide a useful good-quality service , rather than a bad one. They know that if even one of their patients dies as a result of a medical complication , they may be beaten up by the relatives . Each death ends up damaging their reputation and their source of livelihood. This is why it's in a quack’s best interests to make sure that he has access to reliable information – and many of them are very eager to learn ! They have a lot of real life practical knowledge, which they have learned from experience. If we teach them the basics : what medicines are useful and which ones are harmful ; what their limitations are ; what the danger signs of some serious illnesses are; and when they need to refer patients to specialists or hospitals, we can make good use of quacks , so that they become productive citizens .

Let’s not treat quacks aP enemy – this is an approach which is doomed to fail. Until we can train enough qualified doctors to provide high quality primary health care to all our citizens ( which is a long way off !) the next best pragmatic approach is to train quacks, so they can do a better job. We need to identify the successful quacks - the ones who have a good reputation, and provide them with mentorship and training, so they can become better at what they are doing !

I agree there are bad quacks – those who are cheats, and who prey on patients’ ignorance. However, this does not mean that we should tar all quacks with the same brush ! For example, many quacks have a superb bedside manner – and their ability to communicate with their patients is brilliant ! These are valuable skills which they have learned after many years of practice – why not make use of them ?If we legitimize the status of quacks, won’t this be unfair on regular doctors who have spent many years training to acquire their professional knowledgebase ? Not necessarily. We are trying to create win-win relationships , where a quack knows his limitations; and will promptly refer the complicated patients to a trained doctors, so that both can continue to co-exist and serve society.